Healthcare Provider Details

I. General information

NPI: 1962367557
Provider Name (Legal Business Name): LANCE HIROSHI BERSTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8751 W CHARLESTON BLVD STE 130
LAS VEGAS NV
89117-5481
US

IV. Provider business mailing address

3784 RUSKIN ST
LAS VEGAS NV
89147-1044
US

V. Phone/Fax

Practice location:
  • Phone: 702-561-0723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberG73-05371
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: